january 2015

Aqueous Shunts

An aqueous shunt is used as a drainage device for patients that have glaucoma in an effort to relieve intraocular pressure. There are two types of devices, those with a plate or reservoir and those without.

First we will discuss those types of devices with a plate because this code set has been modified in 2015 with the development of two new CPT codes and a revision to the two existing codes.

  • 66179 - Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft (New code)
  • 66180 - with graft (Revised code)
  • 66184 - Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft (New code)
  • 66185 - with graft (Revised code)

Prior to 2015 the AMA had indicated that when an aqueous drainage device was inserted and a graft was placed over the tubing to prevent wear through the conjunctiva, the coder could report CPT codes 66180 for insertion of the drainage device and 67255 (scleral reinforcement) for placement of the graft. The changes to the CPT code descriptions in 2015 now include insertion of the drainage device along with placement of the graft all as part of one CPT code, so rather than reporting two codes the coder would now only report 66180 for insertion of the aqueous drainage device with a graft. This is also reflected in the parenthetical notes found under codes 66180 and 66185 which state (Do not report in conjunction with 67255) meaning that the scleral reinforcement code is no longer reported in addition to the device insertion.

For those types of devices without plates or an extraocular reservoir - we most often see the mini-Ex-PRESS shunt which is inserted into the anterior chamber of the eye and is reported with CPT code 66183. The other type of device is known as an iStent which is inserted in conjunction with cataract surgery. One thing the coder needs to watch for is with an iStent the patient should have both a cataract diagnosis and a glaucoma diagnosis. iStent is not indicated for use to prevent a buildup of pressure within the eye after cataract surgery. There must be a glaucoma diagnosis. I have seen instances where the op note will indicate “complex” cataract when the iStent was inserted for this reason but it would not be appropriate to report 66982 because the medical necessity for insertion of the iStent has not been met. Coding for the iStent is done using Category III code 0191T.

HCPCS code C1783 ocular implant, aqueous drainage assist device may be reported for the device keeping in mind however that this HCPCS code has a Medicare N1 Status (packaged device) so it would not be billed on Medicare claims.





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